AB0314 DMARD INITIATION IN OLDER ADULTS WITH NEW DIAGNOSIS OF LATE-ONSET RHEUMATOID ARTHRITIS
Authors: J. Lee, N. Singh, R. Yung, U. Makris, J. Bynum
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> The number of older adults living with rheumatoid arthritis (RA) is growing as the world population is aging. Older adults with RA are less likely to receive disease modifying anti-rheumatic drug (DMARD) despite these medications being effective and generally well tolerated in older adults. Up to one-third of the older RA population are diagnosed after the age of 65 and have late-onset RA (LORA). Older adults with LORA experience more symptomatic and progressive disease, and yet, their treatment in usual care is not well understood. <h3>Objectives</h3> To evaluate initiation of DMARDs in older adults with new diagnosis of LORA. <h3>Methods</h3> In this retrospective observational study, using 20% Medicare data from 2009-2017, we identified adults 66 years of age or older with new diagnosis of LORA without any DMARD use during the 12 months prior to cohort entry. Information on baseline patient characteristics and DMARD initiation during the first 12 months after LORA diagnosis were collected. We also assessed concomitant use of glucocorticoids (GCs) and opioids that are not disease modifying but can improve symptoms of RA. <h3>Results</h3> We identified 25,139 older adults with new diagnosis of LORA in continuous fee-for-service Medicare. Average age at LORA diagnosis was 76.9 (SD 7.6), 76.4% were female, 76.7% were non-Hispanic white, 37.2% had low-income subsidy, and 63.1% had three or more comorbid conditions. Less than one third were initiated on some form of DMARD (28.8%) during the first 12 months after LORA diagnosis. Among those on any DMARDs (N=7252), 87.7% were initiated conventional synthetic DMARD only, 2.2% on biologic DMARD only, and 10.1% on both classes of DMARDs. Concomitant long-term (≥3 months) GC use was greater among those on any DMARD (44.7%) compared to those without DMARD (15.0%). Opioid use was common and observed in 50.4% and 46.9% of those on any DMARD and those without DMARD, respectively. In multivariable analyses, DMARD initiation was associated with younger age, fewer comorbidities, and absence of low-income subsidy status (Table 1). <h3>Conclusion</h3> DMARD use in older adults with new diagnosis of LORA is low despite current clinical practice guidelines recommending early aggressive initiation of treatment. Long-term GC use is common among those on any DMARDs, raising concern for suboptimal DMARD use. Further studies are needed to understand drivers of DMARD use in older adults with LORA. <h3>References</h3> [1] Turkcapar N, Demir O, Atli T, Kopuk M, Turgay M, Kinikli G, Duman M. Late onset rheumatoid arthritis: clinical and laboratory comparisons with younger onset patients. Archives of gerontology and geriatrics. 2006;42(2):225-31. [2] Solomon DH, Yelin E, Katz JN, Lu B, Shaykevich T, Ayanian JZ. Treatment of rheumatoid arthritis in the Medicare Current Beneficiary Survey. Arthritis research &amp; therapy. 2013;15(2):R43. [3] Schmajuk G, Schneeweiss S, Katz JN, Weinblatt ME, Setoguchi S, Avorn J, Levin R, Solomon DH. Treatment of older adult patients diagnosed with rheumatoid arthritis: improved but not optimal. Arthritis and rheumatism. 2007;57(6):928-34. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.